Organization
LAVALLEE CORPORATION
Active
Other names
Phases of Change
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY A LAVALLEE LMFT (CEO)
(801) 695-0386
Entity
Organization
Contact information
Practice address
121 COUNTRY CLUB DR, OGDEN, UT 84405-2704
(801) 695-0386
Mailing address
121 COUNTRY CLUB DR, OGDEN, UT 84405-2704
(801) 695-0386
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
3314093902
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
788007788057
—
UT
Enumeration date
08/06/2007
Last updated
08/06/2007
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